Current AffairsHome births under fire as court case highlights family tragedy

The issue of giving birth at home once again came to the fore this week
after the country's most senior midwife was found guilty of criminal
negligence after overseeing a botched home birth in Prague. A baby boy was
left severely brain damaged after being deprived of oxygen, and later died.
The midwife denies any wrongdoing, and says the complications were
unforeseen and unavoidable.

Ivana Königsmarková, photo: CTK
Ivana Königsmarková, chairwoman of the country's Union of Midwives, was
charged with negligence resulting in grievous bodily harm in a case that
happened in July 2009. Mrs Königsmarková is one of a handful of people
qualified to deliver babies at home in the Czech Republic, and was
approached by a woman in Prague, who'd delivered two previous children in
hospital and wanted to give birth this time at home.

Unfortunately the birth went badly wrong; the baby boy was unable to
breathe and was only revived when an ambulance was called. Despite being
taken to hospital the boy suffered severe brain damage, and died earlier
this year. The case attracted considerable media attention, with the Czech
medical establishment lining up to condemn home births. Dr Petr Velebil is
head of the perinatal programme at the country's oldest maternity hospital,
Podoli, and he had this to say to Czech Television after the case was
brought to court.

"The home is simply not the safest environment in which to give
birth. This is why the Czech medical community tries its utmost to convince
pregnant women of the benefits of giving birth in a medical facility, which
is prepared and therefore equipped to deal with any potential
complications. These complications are usually sudden, immediate, and they
require immediate medical attention."

Illustrative photo
The judge handed down a two-year suspended sentence to Mrs Königsmarková
and banned her from practising as a midwife for five years. Her lawyer,
Adela Horejsi, immediately appealed, claiming the court had refused to hear
crucial evidence and arguments and had instead relied on flawed and biased
testimony from doctors who were known for their opposition to home births.
Mrs Horejsi spoke to me earlier by telephone.

"We are of course convinced our client is innocent, and we sincerely
hope we'll be given the chance to prove this in court. Mrs Königsmarková
followed standards and procedures for home birth that were drawn up abroad,
as such standards do not exist in the Czech Republic. She followed all of
these required procedures to the letter. Unfortunately these 'optimal birth
procedures' as they're called, contravene the standards laid down by the
Czech Gynaecological Association, which are basically the same recommended
medical procedures that are used in hospital births."

And this is the paradox that has led Czech home births to exist in a sort
of legal no-man's land; midwives are legally permitted to deliver babies at
home under the terms of an EU directive. However under Czech law, midwives
must carry out home births using virtually the same conditions as that of a
maternity ward, which is of course almost impossible. No wonder then that
home births are so rare - only about 500 per year, and many of those were
emergency deliveries, rather than planned births.

Illustrative photo
The Czech media has since been alerted to two more cases - one of which
saw a baby suffocating to death after being born with the umbilical cord
round its neck. That case and Mrs Königsmarková's conviction has
reignited what is a passionate debate; opponents of home birth, which is
virtually the entire Czech medical establishment, say it poses
unnecessarily dangers and the state must protect lives.

Supporters point out that babies also die in hospital deliveries, often
through negligence. The Czech Republic, they say, is stuck in a
post-communist paternalistic mindset, refusing to allow a practice which in
western Europe is safe, popular and protected by European law.